Endoscopic biliary drainage of a malignant biliary obstruction (MBO) is a common procedure, but a recog­nized standard of evaluation is lacking. To this end, the Tokyo criteria have been newly proposed and include cer­tain denitions. Recurrent biliary obstruction (RBO) is dened as stent occlusion and migration, and the time to RBO is employed rather than the duration of stent patency. For patients with distal MBO, the preoperative manage­ment has changed to incorporate new developments in neoadjuvant chemotherapies for pancreatic cancer. Self­expandable metallic stents (SEMSs) serve as the current standard. Palliative management requires long-term stent patency, and SEMS use is thus indicated. A covered SEMS serves as the standard for palliative cases with dis­tal MBO because such stents afford a time to RBO that is similar or superior to those of other stents, with a similar rate of adverse events. Furthermore, SEMSs are remov­able. However, the optimal covered SEMS is not yet available, and covered large-bore SEMSs with anti­migration and anti-reux properties remain under evalua­tion. There is currently no standard management for hilar MBO (in either the preoperative or palliative context). Recently, an inside stent placed above the papilla was reported to afford better results than those of conventional stents, but strong evidence is lacking. Endoscopic ultrasound- guided biliary drainage (EUS-BD) serves as a salvage technique when routine endoscopic retrograde